CAJ | 학술논문

动脉瘤显微夹闭术后远隔部位小脑出血13例诊疗体会及文献复习
동맥류현미협폐술후원격부위소뇌출혈13례진료체회급문헌복습
Clinical analysis on 1 3 patients with remote cerebellar hemorrhage and review of the literature

万方数据

卒中与神经疾病卒中與神經疾病 졸중여신경질병

2015年 4期 222-225 ,共4页

刘宝辉%王军民%田道锋%张申起%陈治标%徐海涛%李明昌%蔡强%吴立权%王龙%冀保卫%朱晓楠%邓刚%陈谦学

류보휘%왕군민%전도봉%장신기%진치표%서해도%리명창%채강%오립권%왕룡%기보위%주효남%산강%진겸학

动脉瘤%远隔部位小脑出血%临床表现%发生机制%治疗動脈瘤%遠隔部位小腦齣血%臨床錶現%髮生機製%治療
동맥류%원격부위소뇌출혈%림상표현%발생궤제%치료
Aneurysms%Remote cerebellar hemorrhage%Clinical and imaging manifestation Mecha-nism%Treatment

目的：探讨动脉瘤显微夹闭术后远隔部位小脑出血的临床表现、发生机制、治疗及预后。方法收集2013年9月~2014年12月发生的13例动脉瘤显微夹闭术后远隔性小脑出血的临床病例,分析其临床表现、治疗方法、预后及发生机制。结果13例患者术后表现为头痛10例,神志恍惚 3例,呕吐5例,一侧肢体肌力降低2例,昏迷 3例,麻醉苏醒延迟2例。13例患者中,有6例发生于双侧,7例发生于单侧,3例因出血多(超过10 mL),神志昏迷,行二期或者三期手术(颅内血肿清除术+去骨瓣减压术+脑室外引流术),10例经保守治疗出血全部吸收,13例经积极治疗均恢复良好,顺利出院,分析13例手术记录发现,术中均释放脑脊液降低颅内压操作。结论头痛、呕吐、麻醉苏醒延迟、意识水平下降及肢体肌力降低为动脉瘤显微夹闭术后远隔小脑出血的常见表现。一旦发生远隔部位小脑出血,及早发现,及早治疗,可以降低患者的病死率,改善患者的预后,术中颅内压的骤然改变可能是远隔部位小脑出血发生的机制。
목적：탐토동맥류현미협폐술후원격부위소뇌출혈적림상표현、발생궤제、치료급예후。방법수집2013년9월~2014년12월발생적13례동맥류현미협폐술후원격성소뇌출혈적림상병례,분석기림상표현、치료방법、예후급발생궤제。결과13례환자술후표현위두통10례,신지황홀 3례,구토5례,일측지체기력강저2례,혼미 3례,마취소성연지2례。13례환자중,유6례발생우쌍측,7례발생우단측,3례인출혈다(초과10 mL),신지혼미,행이기혹자삼기수술(로내혈종청제술+거골판감압술+뇌실외인류술),10례경보수치료출혈전부흡수,13례경적겁치료균회복량호,순리출원,분석13례수술기록발현,술중균석방뇌척액강저로내압조작。결론두통、구토、마취소성연지、의식수평하강급지체기력강저위동맥류현미협폐술후원격소뇌출혈적상견표현。일단발생원격부위소뇌출혈,급조발현,급조치료,가이강저환자적병사솔,개선환자적예후,술중로내압적취연개변가능시원격부위소뇌출혈발생적궤제。
Objective to investigate the clinical,imaging manifestation,mechanism,treatment and out-come of remote cerebellar hemorrhage (RCH)after aneurysms microsurgical clipping.Methods A retrospec-tive analysis was made on 13 cases of RCH after aneurysms microsurgical clipping from September 2013 to De-cember 2014 in neurosurgery department of Renmin Hospital Wuhan University.Clinical and imaging manifes-tation,treatment,outcome and mechanism were analyzed.Results Among 13 patients,headache in 10 cases, mind wanders in 3 cases,vomit in 5 cases,lower muscle strength in one side in 2 cases,unconscious in 3 cases, delay of recovery from general anesthesia in 2 cases.Among 13 cases,RCH happens in both sides in 6 cases and in single side in 7 cases.Cerebellar hemorrhage was more than 10ml and unconscious in 3 cases.3 cases were done secondary operation or three-stage operation.Blood was absorbed completely in 10 cases through conservative treatment.All 13 cases was good clinical recovery.Cerebrospinal fluid (CSF)was leaked in all 13 cases of RCH.Conclusions Headache,vomit,delay of recovery from general anesthesia,unconscious and lower muscle strength in one side are the most common clinical manifestation in RCH,Early detection and ear-ly treatment were important in improving the prognosis of RCH patients.The mechanism of RCH may be lea-king of the CSF which induce the intracranial pressure sudden decrease.